Provider Demographics
NPI:1790927804
Name:SERENITY LIFE DBA COMFORT KEEPERS
Entity Type:Organization
Organization Name:SERENITY LIFE DBA COMFORT KEEPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-895-8822
Mailing Address - Street 1:2150 W CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1242
Mailing Address - Country:US
Mailing Address - Phone:208-895-8822
Mailing Address - Fax:208-884-4116
Practice Address - Street 1:2150 W CHERRY LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1242
Practice Address - Country:US
Practice Address - Phone:208-895-8822
Practice Address - Fax:208-884-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807369101Medicaid
ID807329700Medicaid
ID807361000Medicaid